- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.00 / $1,524.00 / $3,728.00
| Facility | | $666.00 | $1,524.00 | $3,728.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,375.14 / $5,077.53 / $11,438.03
| Facility | | $1,375.14 | $5,077.53 | $11,438.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.56 / $7,909.24 / $7,909.24
| Facility | | $844.56 | $7,909.24 | $7,909.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.00 / $425.00 / $425.00
| Facility | | $425.00 | $425.00 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $746.00 / $2,415.00 / $7,085.00
| Facility | | $746.00 | $2,415.00 | $7,085.00 |